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HARVARD UNIT
H
a
a
EYE EXAMINATION
M
Do you wear glasses YES
NO
X
an
&
If glassos are worn, give date of last
examination 10.12.40
(Requirement within the last 4 months)
Have you two pairs of glasses YES
NO
(2 pairs required)
Date Dec. 14
Signature Ida m. Britton
of
Nurse
O
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